| NPI | 1710663398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1380242) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 3131625) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2024-07-10 |